Provider Demographics
NPI:1174041453
Name:VYAS, POOJA DHARMESH (PT)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:DHARMESH
Last Name:VYAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ALAN TER
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1403
Mailing Address - Country:US
Mailing Address - Phone:516-838-9760
Mailing Address - Fax:
Practice Address - Street 1:22 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5415
Practice Address - Country:US
Practice Address - Phone:718-303-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420992251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics